Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- nil
For clinical advice, please telephone the relevant specialty service.
Dementia Support Australia Hotline
Central Adelaide Local Health Network
- Royal Adelaide Hospital - (08) 7074 0000
- The Queen Elizabeth Hospital - (08) 8222 6000
Northern Adelaide Local Health Network
- Modbury Hospital - (08) 8161 2000
Southern Adelaide Local Health Network
- Flinders Medical Centre - (08) 8404 2269
Exclusions
- driving assessments — refer to local Driving Fitness Assessment Clinic, including Occupational Therapy Driver Assessment Clinic
- post-concussive symptoms - refer to South Australia Brain Injury Rehabilitation Services (SA BIRS)
- head trauma/suspected head injury not meeting threshold for emergency presentation – refer to Neurosurgery
- improving/resolving delirium
- primary psychiatric condition – consider referral to the Older Persons Mental Health Service
- testamentary capacity assessment
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- people aged greater than 65 years at high risk of hospital admission with one or more of the following:
- multiple complex medical problems
- progressive frailty and functional decline
- polypharmacy with associated adverse effects or concerns of drug interactions, minimum of 5 prescribed medications
- people identifying as Aboriginal and/or Torres Strait Islander aged less than 50 years
at high risk of hospital admission with one or more of the following:
- multiple complex medical problems
- progressive frailty and functional decline
- polypharmacy with associated adverse effects or concerns of drug interactions, minimum of 5 prescribed medications
Category 2 (appointment clinically indicated within 90 days)
- people identifying as Aboriginal and/or Torres Strait Islander aged greater than 50 years
at low/moderate risk of hospital admission, requiring geriatric assessment with one or more of the following:
- multiple complex medical problems
- progressive frailty and functional decline
- polypharmacy without associated adverse effects or concerns of drug interactions, minimum of 5 prescribed medications
- people aged greater than 65 years at low/moderate risk of hospital admission, requiring geriatric assessment with one or more of the following:
- multiple complex medical problems
- progressive frailty and functional decline
- polypharmacy without associated adverse effects or concerns of drug interactions, minimum of 5 prescribed medications
Category 3 (appointment clinically indicated within 365 days)
- people identifying as Aboriginal and/or Torres Strait Islander aged greater than 50 years for geriatric assessment
- people aged greater than 65 years for geriatric assessment
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- under the custody or guardianship
- care-giver or third-party contact details, if patient consenting
- advanced care directives status
- age
- past medical/surgical/psychosocial history
- current medications and dosages, including:
- over the counter medications and complementary medicines, and indications
- flag specific drugs causing concern
- medication adherence
- use of any medication administration aids
- home medicines review or residential medication management review
- adverse reactions or medication-related hospitalisations
- use of any medication administration aids
- history of attempts to wean or cease specific medications
- allergies and sensitivities
- use/ frequency of alcohol, tobacco, and other drugs
- presenting symptoms including,
- onset, triggers and progression
- functional impact on quality of life
- treatments trialled/implemented prior to referral
- management history including:
- allied health assessment reports
- family/informal supports and frequency of visits
- National Disability Insurance Scheme (NDIS) / My Aged Care service providers and frequency of visits
- cognitive assessment
- depression screening score
- height/weight
- body mass index (BMI)
- blood pressure
- pathology:
- complete blood examination (CBE)
- urea, electrolyte, and creatinine (UEC)
- liver function test (LFT)
- mid-stream urine specimen (MSU)
- relevant diagnostic/imaging reports including location of company and accession number
Additional information to assist triage categorisation
- copy advance care directives
- driver’s licence status
- list of all clinicians involved in prescribing medications and contact information
Clinical management advice
People residing in high-level aged care facilities may be directed to Local Health Network (LHN) community in-reach teams for assessment at their residence where appropriate.
If polypharmacy, or drug interaction is suspected, consider referring for a home medicines review/residential medication management review.
Elderly patients may experience diminished appetite, dental issues, swallowing difficulties, and chronic medical conditions, all of which can contribute to malnutrition. Allied health professionals, including dietitians, speech pathologists, occupational therapists, and physiotherapists, are essential in assessing and managing these complexities. They collaborate to develop tailored nutrition plans, improve oral health, facilitate safe swallowing, improve safety barriers within the home, and enhance mobility, ultimately promoting better nutritional outcomes and overall quality of life. Allied health involvement should be considered in conjunction to referrals for specialist medical assessment.
Outpatient services are not meant to substitute for care and assistance available through other health programs that elderly patients might qualify for, such as services provided by My Aged Care or the National Disability Insurance Scheme (NDIS).
Clinical resources
- My Aged Care: Health professionals
- National Disability Insurance Scheme (NDIS) - Information for health professionals
- Australian Medical Association - New Stolen Generation resources for GPs
- Capacity Australia - About decision making capacity
- Dementia Australia – Cognitive screening and assessment
- Dementia Australia – Help sheets
- Dementia Australia - Kimberley Indigenous Cognitive Assessment Tool (KICA)
- Dementia Care for Research Collaboration - Dementia Outcomes Measurement Suite: Behaviour Measures & Tools
- Dementia Support Australia - Behaviour Support Process Flowchart
- Dementia Support Australia – Dementia Behaviour Management Advisory Service
- Australian Indigenous Health InfoNet - Let's CHAT dementia resources: best-practice guide and GP management recommendations
- My Licence – My car licence: Older drivers
- HealthPathways SA – Cognitive Impairment and Dementia log in required
- HealthPathways SA – Medication Management Review log in required
- HealthPathways SA – Unexpected Deterioration in an Older Person log in required
- JAMA Internal Medicine - Reducing Inappropriate Polypharmacy: The Process of Deprescribing
- Pharmacy Programs Administrator - Home Medicines Review
- Royal Australian College of General Practitioners (RACGP) - Acute
Confusion in The Elderly: Causes and Management Implication (PDF 1039KB) - RACGP – Silver Book: Dementia
- South Australian Civil and Administrative Tribunal (SACAT) – Consent to medical treatment
- SACAT – Fact sheets and guides
Consumer resources
- My Aged Care
- National Disability Insurance Scheme (NDIS)
- Capacity Australia - About Decision Making Capacity
- Council on the Ageing (COTA) South Australia - Programs and Services
- Cognitive Decline Partnership Centre - Diagnosis, Treatment and Care For People With Dementia – A Consumer Companion Guide
- Dementia Australia
- Dementia Australia – Help sheets
- Dementia Support Australia
- My Licence – My car licence: Older drivers
- Elm Place - The Stolen Generation Support Services
- SA Health - Stop elder abuse
Reason for request
- to establish a diagnosis
- for treatment or intervention
- for advice and management
- for specialist to take over management
- for a specified test/investigation the General Practitioner cannot order
- for other reason (e.g. rapidly accelerating disease progression)
- transfer of care from another tertiary service
- clinical judgement indicates a referral for specialist review is necessary.
Patient demographic details
- full name, including aliases
- date of birth
- residential and postal address
- telephone contact number/s – home, mobile and alternative
- Medicare number, where eligible
- name of the parent or caregiver, if appropriate
- preferred language and interpreter requirements
- identifies as Aboriginal and/or Torres Strait Islander
Clinical modifiers
- impact on employment
- impact on education
- impact on home
- impact on activities of daily living
- impact on ability to care for others
- impact on personal frailty or safety
- identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery, where surgery is a likely intervention.
- Choice to be treated as a public or private patient.
- Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
- Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
- Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
- Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
- A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
- All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.